In Pennsylvania, two distinct statements guide the management of healthcare worker exposure to pathogens. The Occupational Safety and Health Administration's bloodborne pathogen standard provides information to mitigate the risk of healthcare worker exposure, while Pennsylvania's Medical Care Availability and Reduction of Error Act (MCARE) addresses the safety of patients and healthcare workers. MCARE stresses patient screening for multidrug-resistant organisms (MDROs) and isolation precautions, including the use of personal protective equipment to protect healthcare workers and other patients they encounter from exposure to these organisms. Herein, the authors examine the relationship between achievement, avoidance of failure, and personal risk in terms of worker compliance with isolation and related procedures. The authors explore situational and isolation precaution awareness, to describe healthcare-worker behavior in an environment where isolation precautions are indicated. Review of 2013 and 2014 National Healthcare Safety Network infection events demonstrated a decrease in the number of MDRO events during this time period. Event narratives, reported through the Pennsylvania Patient Safety Reporting System, identified isolation precaution breaches during this period that suggest gaps in knowledge, communication, and administrative engagement. Gaps identified in the qualitative data were used to develop a conceptual framework for simulation and other activities designed to improve facility-wide isolation precaution awareness.
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